HomeMy WebLinkAboutInsurance Certificate: Gerald Hermanson
Costello Insurance Associates, Inc.
OM VU on
INSCIR NCE
April 5, 2017
City of Ashland, Admin Dept
Public Works Director
20 E Main Street
Ashland, OR 97520
INSURANCE SHOWING
ADDITIONAL INSURED (LIABILITY) INTEREST
Owner: Gerald H Hermanson
Property: Glider N689P
Company: AIG Aerospace
Policy No.: SS9083347-06
Effective Date: March 30, 2017
Term: 1 Year
The enclosure shown below protects your interest in the above property in
accordance with the policy provisions. Please advise if any corrections are
necessary.
Enclosed: insurance certificate with additional insured wording
Best Regards,
Riley Clark
Y
P. 0. BOX 28280 / 428 E. SOUTHERN AVENUE / TEMPE, AZ. 85285-8280
TEL: 480-968-7746 / 800-528-6483 / FAX: 480-967-3828 / insure@aviationi.com
AIG AEROSPACE INSURANCE SERVICES, INC.
CERTIFICATE OF INSURANCE
THIS IS TO CERTIFY TO: CITY OF ASHLAND, ADMINISTRATION DEPARTMENT,
PUBLIC WORKS DIRECTOR, 20 E. MAIN ST
ASHLAND, OR 97520
THAT THE FOLLOWING POLICY/IES OF INSURANCE HAS/HAVE BEEN ISSUED TO:
GERALD H. HERMANSON
680 S OREGON STREET
JACKSONVILLE, OR 97530, USA
POLICY NO. SS 009083347-06
POLICY PERIOD: From March 30, 2017 to March 30, 2018
INSURANCE COMPANY NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA
Coverage only applies as indicated by a specific limit and deductible.
Limits of Liability
A. Aircraft Liability Single Limit for Bodily Injury and $ 1,000,000. each occurrence
Property Damage Ex cluding Passengers, but
Passenger Bodily Injury Limited within the Single
Limit to $ 0. each passenger
B. Medical Expense In cluding crew $ 10,000. each passenger
C. Physical Damage to Your Aircraft
Coverage Type and Deductibles
Not-in- Not-in-
ID Number Year Make and Model Agreed Value Motion Flight Flight
N689P 2003 WINDWARD $ 35,000. $ $ $
$ 0. 0. 0.
THIS CERTIFICATE HOLDER IS:
1. included as additional insured as respects liability coverage but coverage only applies after all other coverage available to the
additional insured has been exhausted;
2. included as additional insured as respects liability coverage but coverage only applies with respect to the vicarious
responsibility of the additional insured for the operation of the aircraft by the Named Insured, including any interest in the
aircraft as owner/lessor;
3. included as additional insured as respects liability coverage but coverage does not apply to any occurrence arising from the
design, manufacture, modification, repair, sale, or servicing of insured aircraft other than ground handling.
30 days notice of cancellation
Coverage is subject to Date Recognition Exclusion Clause.
The Aviation Managers has made provision to give the certificate holder prompt notice of cancellation of any policy
above. But, the Aviation Managers assumes no responsibility for failure to provide such notice. This certificate
does not change in any way the actual coverages provided by the policy/ies specified above.
Certificate No. 12149414-14 { { ~~~1
Date of Issue April 3, 2017 (Authorized Representative)
LAD30B (10/16)